Martin C. Misiura, DDS
Individual provider Active NPI Dentist · Olyphant, PA
NPI 1720150402 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720150402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 025729 (PA)
- Practice address
- 418 Lackawanna Ave
Olyphant, PA 18447-1524 - Phone
- (570) 489-5611
- Fax
- (570) 489-3388
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025729 | PA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 025729 | PA | Yes |
Addresses
Primary practice location
418 Lackawanna Ave
Olyphant, PA 18447-1524
Mailing address
418 Lackawanna Ave
Olyphant, PA 18447-1524
Phone (570) 489-5611
Other providers in Olyphant, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.